World's second face transplant performed in China

A severely disfigured man in China has become the second person in the world to receive a partial face transplant. Experts predict the number of these operations will rise rapidly as centres around the world gear up to perform the procedure.

Thirty-year-old Li Guoxing received a new upper lip, cheek and nose from a brain-dead donor to repair injuries sustained after an attack by a black bear (see image, below right), according to state media. He was reported to be in a stable condition and taking liquid food following the 13-hour surgery on Thursday at Xijing hospital in the central city of Xi'an, China.

"The surgery scar will not be obvious but there is a difference in the donor's and recipient's skin colour, so that will be noticeable," said Zhang Hui, the doctor in charge of post-surgery treatment, speaking to the China Daily newspaper. Having seen his reflection in a mirror, Guoxing is reportedly happy with his new face, which will be improved by further treatment over time.

Guoxing, a farmer, had become a recluse following the horrific bear attack in 2004. Doctors reportedly prepared for the transplant by practicing on rabbits, which were able to blink and move their faces after surgery.

Hui says it will be two months until they are sure that Guoxing has not rejected the new tissue. Until then his doctors will remain especially alert to any signs of rejection.

Potential recipients

The world's first face transplant was performed in France in late November 2005 on the victim of a dog attack. A 38-year-old woman, Isabelle Dinoire, received a triangular graft consisting of the chin, lips and nose of a donor in a pioneering operation at the University Hospital in Amiens.

To date, the French transplant has proven more successful than many experts expected, encouraging centres around the world to prepare for this type of surgery.

In the US alone there may be several hundred people with extreme facial disfigurement who could benefit from face transplants, says plastic surgeon David Young of the University of California, San Francisco, who has been drawing up plans for a face transplant. Burn patients or victims of animal attacks may suffer this type of severe facial disfigurement, as can people with otherwise benign tumours that eat away at the face.

Psychological assessment

Bioethicist Arthur Caplan, at the University of Pennsylvania in Philadelphia, says it is "very likely" that US doctors will perform a face transplant in the next year. But he adds that dozens of the procedures will have to be carried out before physicians have a sense of its efficacy.

Rejection of the transplanted facial tissue could have life-threatening consequences, and the immunosuppressant drugs used to keep this from happening can make a person more prone to certain cancers.

Caplan points out that in addition to assessing the patient's physical health prior to surgery, they should also be assessed to determine how they are likely to react psychologically to seeing a new face when they look in the mirror.

Many ethicists agree that special organ donation guidelines are needed for face transplants, as donors may feel more wary of someone wearing their face than using their heart. "We don't know how the donor side of this went in China," Caplan notes.

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Thirty-year-old Li Guoxing's surgery scars will fade over time, but the difference in the face donor's skin colour will remain (Image: AP)